Do Patients' Views Matter When Measuring Health Care Quality?
I certainly hope so! The fact that this question is even being debated in the health care arena is deeply disturbing to me. Yet some factions of the health care system still resist using patient experience measures and patient satisfaction questionnaires to gauge quality and improve the way services are delivered.
For instance, an exchange of letters in the New York Times that took place earlier this year purported notions such as, "Hospitals aren't hotels," and, "Patients are seldom the best judges of their medical care."
A couple of recent events incited this controversial issue. First, the Centers for Medicare and Medicaid Services are in the process of implementing the Hospital Value-Based Purchasing Program, which includes incentive payments for higher patient experience scores. That's right - how the patients rate the quality of their health care will impact how much providers get reimbursed. In fact, patient experience will account for 30% of the bonus payments, while the other 70% will be determined by more technical measures.
This is a dramatic shift in how quality care is conceptualized (and reimbursed). In the past, health care quality was measured more objectively on indicators such as access to services, wait times in the emergency room, safety incidents, and infection and mortality rates. Only in the last decade or so have patient appraisals and experiences been considered valuable indicators of quality care in addition to the more technical measures.
There's a lot of research supporting the theory that patient experiences are linked to better health care outcomes. For instance, a number of studies have indicated that higher ratings of patient experiences are associated with lower mortality rates among heart patients. Yet one paper - which constituted the second recent event that flared this issue - suggested that higher patient satisfaction was associated with poorer outcomes. Even though this study seems to be an anomaly and has probable methodological problems, those who do not think quality care should be measured even partially through patient experiences have heralded this study as proof that the Hospital Value-Based Purchasing Program is unfair.
Patient-focused care and evaluation simply makes sense. It's a moral, simple concept - health care should focus on the patient and respond to the patient's unique needs, values, and preferences. Health care quality is not just about numbers. It's also about the relationships between patients and the staff members who care for them.
Have you ever felt unheard by your doctor? Have you ever thought that your ideas were discounted by your health care team? Have you ever felt patronized when you asked a question about your treatment? It matters to your recovery, doesn't it? You bet it does.
On the other hand, have you ever felt heard by your doctor? Have you ever thought that your health care team genuinely cared for your well-being? Have you ever felt respected by those who are directing your treatment? It makes a difference in how well you heal, doesn't it? Absolutely.
Hands down, patients' views matter when measuring health care quality. I just hope that the whole health care system learns to embrace this concept sooner rather than later.
Luxford, K. (2012). What does the patient know about quality? International Journal for Quality in Health Care, 24(5), 439-440.